GLP-1 receptor agonists like semaglutide demonstrate paradoxical effects on eating disorders, reducing binge episodes in some patients while potentially triggering pathological dietary restriction and psychiatric complications in others. These medications alter brain reward pathways that govern eating behavior, creating unpredictable responses in vulnerable individuals. The appetite suppression can become extreme, leading to case reports of treatment discontinuation due to dangerous eating patterns. This duality presents a clinical conundrum as obesity and eating disorders frequently co-occur, particularly binge eating disorder. The psychiatric side effects—anxiety, depression, and disordered eating behaviors—compound the complexity of treatment decisions. Given the explosive growth in GLP-1 agonist prescriptions for weight management, these findings demand immediate attention from clinicians. The limited and inconsistent evidence base, often from small trials, leaves practitioners without clear guidelines for identifying at-risk patients. This represents a critical gap in our understanding of these powerful metabolic drugs, especially as they're increasingly used in populations where eating disorders may be undiagnosed or subclinical.